The prognostic significance of elevated serum alkaline phosphatase levels preoperatively in patients with carcinoma of the colon and rectum.

Two hundred and eighty-three patients were observed for a minimum of 38 months after undergoing resection of Dukes' B2, C1 or C2 classification for carcinoma of the colon and rectum. Cumulative recurrence rates were higher in patients with elevated preoperative serum alkaline phosphatase levels. Site specific recurrence rates revealed a lower incidence of metastases to the liver in patients with elevated preoperative alkaline phosphatase levels. Elevated serum alkaline phosphatase values in patients with carcinoma of the colon may reflect hepatic metastases, but when metastases to the liver are not detected at laparotomy, patients with elevated levels of alkaline phosphatase are at no greater risk of having metastases to the liver develop than patients with normal levels.